International Journal of Public Health Science (IJPHS)

Vol. 12, No. 3, September 2023, pp. 1102~1111

ISSN: 2252-8806, DOI: 10.11591/ijphs.v12i3.22553  1102

Nutritional status and dietary patterns of children with

attention deficit hyperactivity disorder in Bangladesh

Abul Kashem Obidul Huq1, Sakera Khatun Mony2,3, Totini Datta Chowdhury2, Ielias Uddin1, Abu
Naim Mohammad Bazlur Rahim1, Tasrin Jahan3,4, Khaleda Hossain Moon2,3, Chowdhury Tasneem
Hasin5, Kazi Mohammad Formuzul Haque6
1
Department of Food Technology and Nutritional Science, Faculty of Life Science, Mawlana Bhashani Science and Technology
University, Tangail, Bangladesh
2
Department of Nutrition, Faculty of Integrated Nutrition and Health Research Center, University of Dhaka, Dhaka, Bangladesh
3
Institute of Nutrition and Food Science, Faculty of Biological Science, University of Dhaka, Dhaka, Bangladesh
4
Department of Public Health Nutrition, Faculty of Science, Primeasia University, Dhaka, Bangladesh
5
Department of Clinical Dietetics and Nutrition, United Hospital Limited, Gulshan, Dhaka, Bangladesh
6
Department of Food Engineering, NPI University, Dhaka, Bangladesh

Article Info ABSTRACT

Article history: A descriptive cross-sectional study was conducted purposively among 45
children who took regular health and nutritional care facilities in the Savoy
Received Sep 29, 2022 Autism Rehabilitation Center at Narayanganj, Bangladesh with the aimed to
Revised May 20, 2023 observe the nutritional status and dietary patterns of the selected attention
Accepted Jun 11, 2023 deficit hyperactivity disorder (ADHD) child. About 24% of the respondents
were well nourished, while 18% of respondents were overweight and 58% of
the children were underweight. Dietary patterns were monotonous, cereals
Keywords: (rice/bread) consumption were higher, whereas daily fish and meat
consumption were very poor such as 4.4% (small fish), 13.3% (large fish),
ADHD and 2.2% (meat) respectively daily. Fruits and vegetables consumption were
Bangladesh also found as poor among the children. It can be concluded that more
Dietary patterns emphasis should be given to the incorporation of meat, fish, fruits and
Nutritional status vegetables daily into the diet of children with providing nutritional care
Rehabilitation center guidelines to the caregivers of these children so that their diet gets more
diversified to ensure macro and micronutrient adequacy. Diet rich with
adequate nutrients and proper behavioral and psychiatric therapy should be
provided in order to control hyperactive-related disorders.
This is an open access article under the CC BY-SA license.

Corresponding Author:
Abul Kashem Obidul Huq
Department of Food Technology and Nutritional Science, Faculty of Life Science
Mawlana Bhashani Science and Technology University
Tangail, Bangladesh
Email: akohuq@yahoo.com

1. INTRODUCTION
Since the 1970s, attention deficit hyperactivity disorder (ADHD) has been recognized as a distinct
illness that affects school-age children and adolescents [1], [2]. It is divided into three types: one where
hyperactivity and impulsivity predominate, one where attention deficit type predominates, and a complex
type where both symptoms are present [3], [4]. Despite being distinct clinical diagnoses, autism spectrum
disorder (ASD) and ADHD have a number of things in common, such as male predominance, early
childhood onset, connections to perinatal and prenatal causes, common comorbidity for one another, and
frequently persistence into adulthood [5]. ADHD and ASD symptoms commonly co-occur. While ASD and
ADHD have some phenotypic overlap, they are each diagnosed according to different standards [6]. Boys are

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Int J Public Health Sci ISSN: 2252-8806  1103

much more likely than girls to experience with ADHD [7]. The reported prevalence of ADHD varies and is
based on age and the diagnostic instruments used, but is estimated to range between 6.7% and 15.5% [8]–
[11] and 5-10% of the population of children in school-age [7]. According to epidemiological research and
meta-analyses, 5-12% of school-age children and adolescents suffer from ADHD [12], [13]. In a prior
comprehensive review, the prevalence of ADHD was determined to be 5.6% worldwide.
There are numerous genetic and environmental factors that contribute to the development of ADHD
[10], [14]. Although nutrition deficiencies and unhealthful diets may have a part in the pathophysiology of
ADHD, it is still thought to be a hereditary illness [10], [14], [15]. While asymmetrical nutrition decreases
growth and brain function and lowers learning and memory capacities in children, adequate nutrition
positively affects a child's growth and development [16].
Unfortunately, it is unknown how many children or people in many underdeveloped nations are
affected by this crippling developmental neurological disorder that lasts a lifetime. The necessity to rapidly
address the needs of persons with ADHD through appropriate epidemiological survey programs is of the
utmost importance. Children with ADHD symptoms can be significantly reduced by adopting healthy eating
habits and a diet rich in minerals and nutrients. Short-term symptom reduction in ADHD patients may be
achieved with both medication and behavioral treatment. Additionally, nutrition treatment can be employed
to support these management strategies.
Study stated that poor eating patterns and frequent consumption of processed foods may be linked to
a higher risk of ADHD in primary school pupils [16]. According to a research, individuals who skip breakfast
more frequently than the normal group had higher levels of ADHD and had poorer dietary habits. Children
who consume more processed foods less frequently than they do vegetables have greater rates of ADHD [4].
Evidence suggested that deficiencies in long-chain polyunsaturated fatty acids and a number of minerals,
including zinc, iron, magnesium, and iodine, may have a major effect on how severe a child's ADHD
symptoms become. The authors of various research also showed how eliminating foods containing artificial
food additives, such as food colors and preservatives, had a good effect on the behavior of ADHD-affected
kids. During a child's rapid growth and development, it is especially crucial to provide an adequate amount of
nutrients and minerals and remove certain dietary items from the diet [4]. Micronutrients, such as vitamins
and minerals, and polyunsaturated fatty acids are two of the main dietary components that have been shown
to be beneficial in the treatment of ADHA. In patients with ADHD both medication and behavioral therapy
reduce symptoms temporarily [17].
Considering the fact, it is important to understand the food habits and nutritional status of children
with ADHD. This study will assist us in controlling ADHD symptoms after we have looked into nutritional
status and food habits. To assess the potential efficacy of the diet in treating the symptoms of ADHD,
additional research in this area is required.

2. METHOD
2.1. Sampling technique and sample size
A cross-sectional study was conducted among 45 children who were receiving regular health and
nutritional care at a rehabilitation center named Savoy Autism Rehabilitation Center located at Narayanganj
district, Bangladesh. Respondents were selected from the study population by purposive sampling method.
The sample size was calculated with 95% confidence interval and 5% margin of error.

2.2. Data collection

A total of 45 participants were recruited for the study and were each asked individually after verbal
agreement of the aim and nature of the investigation was obtained. To gather pertinent data regarding general
information, a standard questionnaire was created; it also asked about socioeconomic status, personal
characteristics, and food preferences. The questionnaire included demographic information like age, sex,
educational qualifications of mothers and fathers, and monthly income. To assess the questionnaire's validity,
the length of the interview, and some of the items' substance, a pre-test was conducted. To ensure content
coverage, the reliability, and the validity of the study, the questionnaires were modified and revised after the
pre-test.
The guardian of subject provided the majority of the necessary information regarding the
socioeconomic status of the respondents, including family size, monthly income, monthly expenses,
respondents' level of education, marital status, occupation, employment patterns, and sources of income.
Other household members who were present during the interview also contributed. Individual measurements
of height and weight were taken, with each measurement being recorded in kilograms using a common
weighing machine. Subjects were asked to stand on the platform without shoes, with their heads erect and
looking straight ahead, to be measured for height using a conventional height measurement scale. The closest
0.1 cm was used to measure height. For the purpose of collecting dietary data, a seven days food frequency
Nutritional status and dietary patterns on children with … (Abul Kashem Obidul Huq)
1104  ISSN: 2252-8806

questionnaire was used. The respondents were questioned about their eating habits in this part. Five
categories of consumption frequency were established: 7 days, 6 to 5 days, 4 to 3 days, 2 to 1 days, and
never. All of the data were entered into the appropriate spaces on the questionnaire.

2.3. Statistical analysis

The Statistical Package for Social Sciences (SPSS) was used to examine the data (version 20.0). The
majority of the statistics were descriptive. The frequency distribution and percentage were examined. Body
mass index (BMI) is measured by calculating weight in kilograms/height in meter square and classified
according to WHO classification of BMI, nutritional status was categorized into three groups, namely
undernutrition: <20, Normal: 20.0-24.9 and overnutrition: 25 and above.

3. RESULTS AND DISCUSSION

Table 1 shows the percent distribution of the respondents’ socioeconomic information. About 20%
of them were four to six years of age and about 31% were seven to nine years of age. Almost half of the
respondents (about 49%) were between ten to twelve years of age. About 60% of children were male and
40% were female. Majority of the mothers of the respondents were housewives, while majority of the fathers
were day laborers or mill workers. It was observed that about 45% of the respondents’ monthly household
income were below fifteen thousand BDT (1 USD= 107.27 BDT BDT (Bangladeshi Taka)), while about 22%
of respondents’ income were between fifteen thousand BDT to twenty thousand BDT. About 76% of
respondents replied that their main caregiver was mother and in case of living place of the respondents, about
87% of them had lived with their family.

Table 1. Percent distribution of the respondents’ socioeconomic information

Socioeconomic variables Frequency (n=45) Percentage (%)
Age of children 4-6 9 20
(in years) 7-9 14 31.1
10-12 22 48.9
Sex of children Male 27 60.0
Female 18 40.0
Occupation of the mothers Garments worker 6 13.3
Housewife 34 75.6
Tailor 3 6.7
Weaving 2 4.4
Occupation of the fathers Labor/mill worker 18 40
Garments worker 6 13.3
Auto-rickshaw driver 9 20
Shopkeeper/grocers/small businessman 5 11.1
Farmer 2 4.4
Weaving 1 2.2
Unemployed 4 8.9
Monthly household income <10,000 3 6.
(in BDT) 10,000-14,999 20 44.4
15,000-19,999 10 22.2
20,000-24,999 10 22.2
≥25,000 2 4.4
Main care provider in family Mother 34 75.5
Father 3 6.7
Grandmother 3 6.7
Grandfather 1 2.2
Grandmother plus sister 4 8.9
Child living place With family 39 86.7
Others 6 13.3

Figure 1 depicts the nutritional status of the children. The average height of the children was 125±6
cm and their average weight was found 28±4.5 kg. It can be seen from the above table that about 24% of the
respondents were in normal status measured by BMI-for-age, while 18% of respondents were overweight.
The frequency of obesity was reported to be 18.0% in a study with 279 children and adolescents
who were mentally retarded [18]. A study stated that about 2.6% of the children were underweight, 17.1%
were overweight, and 14.5% were obese [19]. A scoping review showed that overweight is more prone to
younger children with neurodevelopmental condition compared to normal developing children [19]. A study
of overweight children in Italy found that they had worse gross motor abilities than their normal-weight peers

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[20], while other systematic reviews found that overweight children had less executive control and more
trouble with inhibition than children of healthy weight [21]. A study carried out on nutritional status and
dietary patterns of children with autism and it was discovered that 11.9%, 19.7%, and 23.3% of the
individuals were underweight, overweight, and obese, respectively [22]. About 58% of the children were
underweight. According to a Chinese study, children with ASD have a higher risk of nutrient deficiencies and
have geographical variations in their nutritional condition [23]. The ratio of stunting was reported to be
33.5% among all children in a study that investigated the nutritional condition of children with impairments.
It was also stated that the ratio of stunting increased with age, with females being more likely to become
stunted than boys [24].

Figure 1. Nutritional status of the respondents by BMI-for-age

On the other hand, Figure 2 shows the scenario of different types of therapies received by the
respondents in the center. It is evident that about 43% of respondents had received physical therapy, about
10% respondents had received behavioral therapy, about 30% had received speech therapy, and occupational
therapy was received by about 13% respondents, while only about 3% of respondents were found to receive
no therapies. There is evidence that children with neurodevelopmental condition who receive physical
therapy may have considerable improvements in their motor skills [25]. Children with autism spectrum
disorders benefit from speech and language therapy by improving their vocabulary, verbal and nonverbal
communication, sentence construction, and speech [26]. A study showed that the cognitive behavioral
therapy (CBT) group dramatically improved on tests of ADHD knowledge, self-efficacy, and self-esteem
than the control group [27]. About 43 persons with ADHD participated in an open study that found that
receiving combination treatment is linked to significant improvements on all clinical metrics [28].

Figure 2. Respondents by different types of therapies they received in the center

According to a study, many management strategies are used to treat ASD in order to improve
quality of life. Some examples of these are counseling, speech therapy, occupational therapy, music and
movement therapy, special education, art therapy and animal therapy. The five top-rated reviews and the
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ADHD literature have combined their findings to demonstrate that psychosocial treatments help to improve
behavioral and social outcomes [29]. A long-term use of stimulants like methylphenidate, dexamphetamine,
and its derivatives is frequently linked to the standard treatment, which combines behavioral and psychiatric
therapy with medicine [30]. It appears that supplement use helps lessen some children's hyperactive behavior
[31], [32] CBT is a successful treatment for people with ADHD, according to one study. Combining CBT
with medication led to greater gains in executive functions than CBT alone, but not in clinical symptoms
[33].
Table 2 shows the picture of dietary patterns provided to the neurodevelopmental disorder children
attending the rehabilitation center taken by seven days food frequency questionnaire. It was found that about
78% of respondents said that they had rice during the past seven days, while only 4% of them denied to have
rice during past seven days. In case of bread consumption, about 36% replied to have bread for four to three
days, while about 13% did not take any bread during the past week. Regarding the consumption of animal
protein sources by the respondents, only 4% said that they had eaten small fish daily, while about 34% did
not have small fish during past week. About 13% of respondents have large fish daily, whereas, 11% of them
replied that they had not eaten any kind of large fish during past week. About 42% respondents said that they
took meat for four to three days, and 20% said that they did not have any meat during past week. In
comparison with other protein sources, (both animal and protein), milk consumption was found to be higher.

Table 2. Dietary patterns of the respondents by seven-day food frequency questionnaire

Food groups 7D 6D to 5D 4D to 3D 2D to1D Never
Cereals Rice n 35 3 5 0 2
% 77.8 6.7 11.1 0 4.4
Bread n 11 3 16 9 6
% 24.4 6.7 35.6 20 13.3
Animal protein Fish (small) n 2 13 9 6 15
% 4.4 28.9 20 13.3 33.3
Fish (large) n 6 3 18 13 5
% 13.3 6.7 40 28.9 11.1
Meat n 1 3 19 13 9
% 2.2 6.7 42.2 28.9 20
Milk n 28 0 5 8 4
% 63.3 0 10 16.7 10
Eggs n 27 4 9 3 2
% 60 10 20 6.7 3.3
Plant protein Pulses n 18 12 9 3 3
% 40 26.7 20 6.7 6.7
Fruits Fruits n 3 3 21 9 9
% 6.7 6.7 46.7 20 20
Vegetables Leafy n 20 8 6 6 5
% 43.3 16.7 13.3 13.3 11.1
Others n 14 9 9 4 9
% 30 20 20 10 20

About 63% respondents replied that they had taken milk daily during past week, while only 10% did
not take milk and about 60% said that they had eaten eggs daily on past week while only 3% of respondents
replied to have no eggs. About half of the respondents (47%) were found to have fruits for three to four days.
In case of vegetables consumption, it was found that about 43% of respondents had eaten leafy vegetables
daily and 30% respondents had eaten other type of vegetables daily. Simple sugars, processed and ultra-
processed carbs, both low- and high-fat animal proteins, and considerably less servings of vegetables and
fruits were ingested by children with neurodevelopmental disorder [34]. Results from a study stated that the
severity of neurodevelopmental conditions and associated atypical behaviors may be lessened by customizing
a balanced diet with the right micronutrient supplements [35]. According to a research, children with ADHD
consumed significantly more simple sweets, tea, and prepared foods than children in the control group, but
significantly less protein, vitamin B1, vitamin B2, vitamin C, zinc, and calcium [36]. Children with ADHD
had a decreased intake of dairy and vitamin B2 compared to the control group, and a greater intake of refined
carbohydrates. It was also found that patients with ADHD may be significantly separated from healthy
controls by their composite dietary and nutritional scores [37].
Children with ASD were found to eat significantly more daily servings of sweetened beverages and
snack foods than typically developing kids, as well as significantly fewer daily servings of fruits and
vegetables [38]. Healthy controls and children with ADHD seem to have distinct eating habits [10], [14],
[37]. Growing evidence points to the potential significance of nutrition, lifestyle, and nutrients in the

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pathogenesis and treatment of mental illnesses [39], including ADHD [40]. Children with ADHD had lower
intakes of dairy, calcium, and vitamin B-2 and greater intakes of refined carbohydrates [37]. The interaction
between diet and lifestyle should be more prominently included in studies on treatment strategies for ADHD
because diet and nutrition interact with other lifestyle factors, such as physical activity [41]. In addition, a
survey found that 93.06%, 90.28%, 80.56%, and 62.50% of ASD children did not consume enough fruit, fish,
vegetables, or water on a regular basis [42].
ADHD risk has decreased by up to 37% with a "healthy" diet high in fruits, vegetables, legumes,
and fish. Adherence to the "Western" dietary pattern, which includes red meat, refined grains, processed
meats, and hydrogenated fat, as well as the "junk food" pattern, which includes sweetened beverages and
desserts, increased it [43]. The research revealed that unhealthy eating habits had a negative correlation with
ADHD whereas good ones had a favorable correlation. Regarding dietary supplements, only vitamin D and
vitamin D + magnesium seemed to lessen the symptoms of ADHD [44]. Micronutrients, such as vitamins and
minerals, and polyunsaturated fatty acids are two of the main dietary components that have been shown to be
beneficial in the treatment of ADHD. According to a number of studies conducted on a group level,
individuals with ADHD have lower blood plasma levels of several minerals, such as magnesium, iron, and
zinc and their treatment may lessen ADHD symptoms in people with the corresponding deficiencies [45]. It
is debatable how omega-3 polyunsaturated fatty acids (PUFAs) affect the pathogenesis and treatment of
ADHD [40]. The effectiveness of omega-3 polyunsaturated fatty acid (PUFA) supplementation on the
primary symptoms of ADHD is presently not well established.
A systematic review displayed that two dietary therapies that appear to have the greatest potential
for reducing the symptoms of ADHD in children are elimination diets and fish oil supplements [46]. Recent
studies have looked at dietary patterns, complete diets, and other lifestyle-related factors instead of evaluating
the impact of individual micronutrients in children with ADHD. According to the results of these studies, the
overall diet should be taken into account rather than concentrating on certain micronutrients [45]. A poor
nutritional biochemistry status that affects ADHD behaviors may be preceded by unhealthy eating habits,
therefore managing one's food and nutrition should always be taken into account as a means to reduce the
symptoms of ADHD.
Figure 3 depicts the percent distribution of respondents under special diet. It was observed that
respondents were having different types of specially modified nutritional care such as about 27% was
receiving gluten-free diet, 20% was receiving casein-free diet, only 10% was receiving yeast-free diet,
whereas, about 44% of the respondents was receiving high-protein diet. Majority of them (about 82%) was
receiving sugar-free diet. About 33% of them was receiving supplements. It is investigated whether nutrition
(gluten-free/casein-free diet and special carbohydrate diet) is a component of current ASD treatment and
whether it has any positive impacts [47]. It is well known fact that ADHD and the symptoms of ASD usually
co-occur. But there is minimal proof that a gluten-free and casein-free (GFCF) diet is helpful for a child's
ASD symptoms [48]. Food colorants and preservatives should be avoided as well as sugar and sweeteners in
order to improve behavior and attention in ADHD youngsters. Despite the prevalence of the gluten-free diet,
children with a documented food allergy, such as celiac disease, a wheat allergy, or a non-celiac gluten
sensitivity (NCGS), should only follow these diets. Elimination diets are generally only recommended for
usage with kids who have known sensitivities to the food being avoided [49].

Figure 3. Percent distribution of respondents under special diet

Nutritional status and dietary patterns on children with … (Abul Kashem Obidul Huq)
1108  ISSN: 2252-8806

4. CONCLUSION
Therefore, it is recommended that the rehabilitation centers of Bangladesh along with the principal care
giver of the patient should be concern about ensuring the proper nutritional care of these children so that their diet
get more diversified to ensure macro and micronutrient adequacy. The dietary habits of children with ADHD are
distinctive, and nutritional factors may play a role in the pathophysiology of ADHD. When evaluating children
with ADHD routinely, clinicians should take into account dietary practices and particular nutrients.

ACKNOWLEDGEMENTS
The authors declare no conflict of interest as no financial support received from any grant or
organization However, the authors would like to highly acknowledge Professor Dr. K.M. Formuzul Haque,
Adviser of Integrated Nutrition and Health Research Center (INHRC), Dhaka and the authority of Savoy
Autism Rehabilitation Center, Narayanganj for their communication supports during data collection period.

REFERENCES
[1] S. Ryu et al., “Associations between dietary intake and attention deficit hyperactivity disorder (ADHD) Scores by repeated
measurements in school-age children,” Nutrients, vol. 14, no. 14, p. 2919, 2022, doi: 10.3390/nu14142919.
[2] M. Fuentes-Albero, M. I. Martínez-Martínez, and O. Cauli, “Omega-3 long-chain polyunsaturated fatty acids intake in children
with attention deficit and hyperactivity disorder,” Brain Sciences, vol. 9, no. 5, p. 120, 2019, doi: 10.3390/brainsci9050120.
[3] V. Leventakou et al., “Is there an association between eating behaviour and attention‐deficit/hyperactivity disorder symptoms in
preschool children?,” Journal of Child Psychology and Psychiatry, vol. 57, no. 6, pp. 676–684, 2016, doi: 10.1111/jcpp.12504.
[4] K. Konikowska, B. Regulska-Ilow, and D. Rózańska, “The influence of components of diet on the symptoms of ADHD in
children,” Rocz Panstw Zakl Hig, vol. 63, no. 2, pp. 127–134, 2012.
[5] Y. Ji, R. Raghavan, and X. Wang, “Early life origins of ASD and ADHD,” Oxford Research Encyclopedia of Global Public
Health. Oxford University Press, 2021. doi: 10.1093/acrefore/9780190632366.013.181.
[6] Y. Leitner, “The co-occurrence of autism and attention deficit hyperactivity disorder in children – what do we know?,”
Frontiers in Human Neuroscience, vol. 8, p. 268, 2014, doi: 10.3389/fnhum.2014.00268.
[7] S. V Faraone, J. Sergeant, C. Gillberg, and J. Biederman, “The worldwide prevalence of ADHD: is it an American condition?,”
World Psychiatry, vol. 2, no. 2, pp. 104–113, 2003.
[8] M. Abel et al., “Maternal iodine intake and offspring attention-deficit/hyperactivity disorder: results from a large prospective
cohort study,” Nutrients, vol. 9, no. 11, p. 1239, 2017, doi: 10.3390/nu9111239.
[9] A. Bowling, K. Davison, S. Haneuse, W. Beardslee, and D. P. Miller, “ADHD medication, dietary patterns, physical activity, and
BMI in children: a longitudinal analysis of the ECLS-K study,” Obesity, vol. 25, no. 10, pp. 1802–1808, 2017, doi:
10.1002/oby.21949.
[10] S. Yan et al., “Dietary patterns are associated with attention-deficit/hyperactivity disorder (ADHD) symptoms among
preschoolers in mainland China,” European Journal of Clinical Nutrition, vol. 72, no. 11, pp. 1517–1523, 2018, doi:
10.1038/s41430-018-0131-0.
[11] A. S. Rowland et al., “The prevalence of ADHD in a population-based sample,” Journal of Attention Disorders, vol. 19, no. 9, pp.
741–754, 2015, doi: 10.1177/1087054713513799.
[12] X. Wu, A. Ohinmaa, and P. Veugelers, “The influence of health behaviours in childhood on attention deficit and hyperactivity
disorder in adolescence,” Nutrients, vol. 8, no. 12, p. 788, 2016, doi: 10.3390/nu8120788.
[13] K. M. Kim et al., “Associations between attention-deficit/hyperactivity disorder symptoms and dietary habits in elementary
school children,” Appetite, vol. 127, pp. 274–279, 2018, doi: 10.1016/j.appet.2018.05.004.
[14] L.-J. Wang et al., “Dietary profiles, nutritional biochemistry status, and attention-deficit/hyperactivity disorder: path analysis for a
case-control study,” Journal of Clinical Medicine, vol. 8, no. 5, p. 709, 2019, doi: 10.3390/jcm8050709.
[15] J. G. Millichap and M. M. Yee, “The diet factor in attention-deficit/hyperactivity disorder,” Pediatrics, vol. 129, no. 2, pp. 330–
337, 2012, doi: 10.1542/peds.2011-2199.
[16] N.-S. Koo, K.-O. Koo, and J. Chung, “Study on dietary factors associated with characteristics of attention deficit hyperactivity
disorder,” Journal of the Korean Society of Food Culture, vol. 27, no. 5, pp. 544–551, 2012, doi: 10.7318/KJFC/2012.27.5.544.
[17] J.-D. Lin, C.-F. Yen, C.-W. Li, and J.-L. Wu, “Patterns of obesity among children and adolescents with intellectual disabilities in
Taiwan,” Journal of Applied Research in Intellectual Disabilities, vol. 18, no. 2, pp. 123–129, 2005, doi: 10.1111/j.1468-
3148.2005.00241.x.
[18] C. M. İnan and A. Ö. Özçelik, “Nutritional status and feeding behavior problems of turkish children with special learning
disabilities,” Research Square. 2022. [Online]. Available: https://assets.researchsquare.com/files/rs-1739439/v1/030da912-26cc-
43aa-ae48-ad4fe025a8de.pdf?c=1655414667
[19] N. S. M. Nor, N. S. A. Aziz, C. S. Man, R. Ambak, and M. A. Omar, “Nutritional status of children with autism spectrum
disorders, cerebral palsy and down syndrome: a scoping review,” The Open Access Journal of Science and Technology, vol. 3, pp.
1–11, 2015, doi: 10.11131/2015/101174.
[20] M. Morano, D. Colella, and M. Caroli, “Gross motor skill performance in a sample of overweight and non-overweight preschool
children,” International Journal of Pediatric Obesity, vol. 6, no. S2, pp. 42–46, 2011, doi: 10.3109/17477166.2011.613665.
[21] J. Liang, B. E. Matheson, W. H. Kaye, and K. N. Boutelle, “Neurocognitive correlates of obesity and obesity-related behaviors in
children and adolescents,” International Journal of Obesity, vol. 38, no. 4, pp. 494–506, 2014, doi: 10.1038/ijo.2013.142.
[22] M. N. Islam, F. S. Bari, S. M. Chayon, F. Yesmin, S. Akter, and S. B. Kashem, “A cross-sectional study on nutritional status and
dietary patterns of children with autism,” Malaysian Journal of Nutrition, vol. 26, no. 3, pp. 401–410, 2020, doi: 10.31246/mjn-
2019-0126.
[23] J. Zhu et al., “Nutritional status and symptoms in preschool children with autism spectrum disorder: a two-center comparative
study in chongqing and hainan province, China,” Frontiers in Pediatrics, vol. 8, pp. 1–11, 2020, doi: 10.3389/fped.2020.00469.
[24] A. M. AbdAllah, S. S. A. El-Sherbeny, and S. Khairy, “Nutritional status of mentally disabled children in Egypt,” The Egyptian
Journal of Hospital Medicine, vol. 29, no. 1, pp. 604–615, 2007, doi: 10.21608/ejhm.2007.17704.

Int J Public Health Sci, Vol. 12, No. 3, September 2023: 1102-1111
Int J Public Health Sci ISSN: 2252-8806  1109

[25] H. A. Lim, “Effect of ‘developmental speech and language training through music’ on speech production in children with autism
spectrum disorders,” Journal of Music Therapy, vol. 47, no. 1, pp. 2–26, 2010, doi: 10.1093/jmt/47.1.2.
[26] M. Djordjević, H. Memisevic, S. Potic, and U. Djuric, “Exercise-based interventions aimed at improving balance in children with
autism spectrum disorder: a meta-analysis,” Perceptual and Motor Skills, vol. 129, pp. 90–119, 2022.
[27] J. Bramham, S. Young, A. Bickerdike, D. Spain, D. McCartan, and K. Xenitidis, “Evaluation of group cognitive behavioral
therapy for adults With ADHD,” Journal of Attention Disorders, vol. 12, no. 5, pp. 434–441, 2009, doi:
10.1177/1087054708314596.
[28] A. L. Rostain and J. R. Ramsay, “A combined treatment approach for adults with ADHD—results of an open study of 43
patients,” Journal of Attention Disorders, vol. 10, no. 2, pp. 150–159, 2006, doi: 10.1177/1087054706288110.
[29] S. M. R. Watson, C. Richels, A. P. Michalek, and A. Raymer, “Psychosocial treatments for ADHD,” Journal of Attention
Disorders, vol. 19, no. 1, pp. 3–10, 2015, doi: 10.1177/1087054712447857.
[30] I. Batool and A. Ijaz, “Effectiveness of speech and language therapy for autism spectrum disorder,” Journal of Pakistan
Psychiatric Society, vol. 12, no. 1, p. 14, 2015.
[31] E. Konofal, M. Lecendreux, I. Arnulf, and M.-C. Mouren, “Iron deficiency in children with attention-deficit/hyperactivity
disorder,” Archives of Pediatrics & Adolescent Medicine, vol. 158, no. 12, pp. 1113–1115, 2004, doi:
10.1001/archpedi.158.12.1113.
[32] E. Konofal et al., “Effects of iron supplementation on attention deficit hyperactivity disorder in children,” Pediatric Neurology,
vol. 38, no. 1, pp. 20–26, 2008, doi: 10.1016/j.pediatrneurol.2007.08.014.
[33] M.-R. Pan, F. Huang, M.-J. Zhao, Y.-F. Wang, Y.-F. Wang, and Q.-J. Qian, “A comparison of efficacy between cognitive
behavioral therapy (CBT) and CBT combined with medication in adults with attention-deficit/hyperactivity disorder (ADHD),”
Psychiatry Research, vol. 279, pp. 23–33, 2019, doi: 10.1016/j.psychres.2019.06.040.
[34] B. Raspini et al., “Dietary patterns and weight status in italian preschoolers with autism spectrum disorder and typically
developing children,” Nutrients, vol. 13, no. 11, p. 4039, 2021, doi: 10.3390/nu13114039.
[35] N. Meguid, M. Anwar, S. Zaki, W. Kandeel, N. Ahmed, and I. Tewfik, “Dietary patterns of children with autism spectrum
disorder: a study based in Egypt,” Open Access Macedonian Journal of Medical Sciences, vol. 3, no. 2, pp. 262–267, 2015, doi:
10.3889/oamjms.2015.051.
[36] H. Salvat, M. N. Mohammadi, P. Molavi, S. A. Mostafavi, R. Rostami, and M. A. Salehinejad, “Nutrient intake, dietary patterns,
and anthropometric variables of children with ADHD in comparison to healthy controls: a case-control study,” BMC Pediatrics,
vol. 22, no. 1, p. 70, 2022, doi: 10.1186/s12887-022-03123-6.
[37] W.-J. Chou et al., “Dietary and nutrient status of children with attentiondeficit/hyperactivity disorder: A case-control study,” Asia
Pacific Journal Clinical Nutrition, vol. 27, no. 6, pp. 1325–1331, 2018.
[38] E. W. Evans et al., “Dietary patterns and body mass index in children with autism and typically developing children,” Research in
Autism Spectrum Disorders, vol. 6, no. 1, pp. 399–405, 2012, doi: 10.1016/j.rasd.2011.06.014.
[39] K. W. Lange, “Diet, exercise, and mental disorders–public health challenges of the future,” Movement and Nutrition in Health
and Disease, pp. 39–59, 2018.
[40] K. W. Lange, “Dietary factors in the etiology and therapy of attention deficit/hyperactivity disorder,” Current Opinion in Clinical
Nutrition & Metabolic Care, vol. 20, 2017, doi: 10.1097/MCO.0000000000000415.
[41] K. W. Lange, Y. Nakamura, and A. Reissmann, “Diet and food in attention-deficit hyperactivity disorder,” Journal of Future
Foods, vol. 2, no. 2, pp. 112–118, 2022, doi: 10.1016/j.jfutfo.2022.03.008.
[42] D. Ahumada et al., “Eating patterns in children with autism spectrum disorder,” Healthcare, vol. 10, no. 10, p. 1829, 2022, doi:
10.3390/healthcare10101829.
[43] E. Shareghfarid, Z. S. Sangsefidi, A. Salehi-Abargouei, and M. Hosseinzadeh, “Empirically derived dietary patterns and food
groups intake in relation with Attention Deficit/Hyperactivity Disorder (ADHD): A systematic review and meta-analysis,”
Clinical Nutrition ESPEN, vol. 36, pp. 28–35, 2020, doi: 10.1016/j.clnesp.2019.10.013.
[44] S. Pinto, T. Correia-de-Sá, B. Sampaio-Maia, C. Vasconcelos, P. Moreira, and J. Ferreira-Gomes, “Eating Patterns and dietary
interventions in ADHD: a narrative review,” Nutrients, vol. 14, no. 20, p. 4332, 2022, doi: 10.3390/nu14204332.
[45] K. W. Lange, “Micronutrients and diets in the treatment of attention-deficit/hyperactivity disorder: chances and pitfalls,”
Frontiers in Psychiatry, vol. 11, p. 102, 2020, doi: 10.3389/fpsyt.2020.00102.
[46] M. J. H. Rytter et al., “Diet in the treatment of ADHD in children—A systematic review of the literature,” Nordic Journal of
Psychiatry, vol. 69, no. 1, pp. 1–18, 2015, doi: 10.3109/08039488.2014.921933.
[47] B. B. Rodop, E. Başkaya, İ. Altuntaş, and O. Erbaş, “Nutrition effect on autism spectrum disorders,” Journal of Experimental and
Basic Medical Sciences, vol. 2, no. 1, pp. 7–17, 2021.
[48] A. Piwowarczyk, A. Horvath, J. Łukasik, E. Pisula, and H. Szajewska, “Gluten- and casein-free diet and autism spectrum disorders in
children: a systematic review,” European Journal of Nutrition, vol. 57, no. 2, pp. 433–440, 2018, doi: 10.1007/s00394-017-1483-2.
[49] S. Cruchet, Y. Lucero, and V. Cornejo, “Healthy nutritional habits should be encouraged in all children independently of the
existence or non-existence of neurodevelopmental disorders,” Annals of Nutrition & Metabolism, vol. 68, no. 1, pp. 43–50, 2016.

BIOGRAPHIES OF AUTHORS

Abul Kashem Obidul Huq has completed his PhD in polymer chemistry from
University Malaya, Malaysia. Currently employed as a professor at the Mawlana Bhashani
Science and Technology University (MBSTU), Tangail, Bangladesh in the Department of
Food Technology and Nutritional Science. His research interest in public health nutrition,
chemistry, food waste and by product utilization, green nano materials, therapeutic nutrition
and dietetics. He is also eminent scientist in functional food research group and chief advisor,
Integrated Nutrition and Health Research Center, Bangladesh. He can be contacted at email:
akohuq@yahoo.com.

Nutritional status and dietary patterns on children with … (Abul Kashem Obidul Huq)
1110  ISSN: 2252-8806

Sakera Khatun Mony completed her B.Sc. (Honours) and MS in Nutrition and
Food Science from the University of Dhaka, Bangladesh. Her research works focused on
food and nutritional science and public health. She can be contacted at email:
sakera267@gmail.com.

Totini Datta Chowdhury completed her B.Sc. (Honours) and MS in Nutrition

and Food Science from the University of Dhaka, Bangladesh. Now she is working as a senior
dietitian in Integrated Nutrition and Health Research Center, Dhaka. Her research works
focused on therapeutic nutrition and food science. She can be contacted at email:
totinidatta01@gmail.com.

Ielias Uddin is working as a lecturer in the Department of Food Technology and

Nutritional Science in Mawlana Bhashani Science and Technology University, Tangail,
Bangladesh. His areas of study interest include food processing, food preservation,
biomaterials, food waste and by product utilization, social nutrition, public health nutrition
and food safety. He can be contacted at email: ielias.ft18@gmail.com.

Abu Naim Mohammad Bazlur Rahim is a physiotherapist and PhD fellow in

the Department of Food Technology and Nutritional Science in Mawlana Bhashani Science
and Technology University, Tangail, Bangladesh. He completed B.P.T- Bachelor of
Physiotherapy and MS in Physiotherapy at University of Dhaka. His research interest is
obesity management and public health nutrition. He can be contacted at email:
riponphysio@gmail.com.

Tasrin Jahan is working as a lecturer in Paramecia University, Dhaka,

Bangladesh. His research interest is public health nutrition focusing the health and nutrition
of child, mother, adolescent girls, rural and urban health. She completed her B.Sc. (Honours)
and MS in Nutrition and Food Science from the University of Dhaka, Bangladesh. She can be
contacted at email: tasrin.jahan@primeasia.edu.bd.

Int J Public Health Sci, Vol. 12, No. 3, September 2023: 1102-1111
Int J Public Health Sci ISSN: 2252-8806  1111

Khaleda Hossain Moon completed her B.Sc. (Honours) and MS in Nutrition

and Food Science from the University of Dhaka, Bangladesh. She worked as a Former
Technical Manager-Nutrition at SARPV Social Assistance and Rehabilitation for the
Physically Vulnerable. Now she is performing as a project coordinator at Rupantor. She can
be contacted at email: khaledahossainmoon@yahoo.com.

Chowdhury Tasneem Hasin is working as a Chief Clinical Dietitian and HOD,

Department of Clinical Dietetics and Nutrition. She completed her B.Sc. (Honours) and MS
in Nutrition and Food Science from the University of Dhaka, Bangladesh. Her research
disciplines are nutrition and dietetics. She is also experienced in human nutrition, child
nutrition, malnutrition, nutritional and metabolic diseases, childhood obesity, obesity
prevention and critical care nutrition. She can be contacted at email:
tasneemhasin@gmail.com.

Kazi Mohammad Formuzul Haque is a professor and departmental head of

food engineering at NPI University, Dhaka. Bangladesh. His research interest in public
health, nutrition and dietetics, food science and technology. He can be contacted at email:
formuzul@gmail.com.

Nutritional status and dietary patterns on children with … (Abul Kashem Obidul Huq)